BPD in Teenagers

G. Pacana

3/7/20243 min read

BPD teens
BPD teens

“Listen to the children non-judgmentally. Help them trust their own perceptions.”

― Paul T. Mason

Personality disorders like BPD are normally not diagnosed in people under the age of eighteen. However, there is a significant body of evidence that suggests that adolescents can begin to develop BPD before age 18. Recent research indicates that BPD can be reliably diagnosed in adolescents as young as 11 years old.

The Diagnostic and Statistical Manual of Mental Disorders criteria used in diagnosing BPD in adults define BPD in adolescents as a one-year pattern of immature personality development with disturbances in at least five of the following nine areas: efforts to avoid abandonment, unstable interpersonal relationships, identity disturbance, impulsivity, suicidal and self-mutilating behaviors, affective instability, chronic feelings of emptiness, inappropriate intense anger, and stress-related paranoid ideation.

It's important to differentiate BPD symptoms from typical adolescent behavior such as moodiness and impulsive or even reckless behavior. It’s only when these behaviors are persistent, inflexible, and negatively impact functioning that they may be an indication of BPD. However, research indicates that an early diagnosis of BPD in adolescents, when clinically appropriate, significantly improves treatment outcomes.

The symptoms of borderline personality disorder in adolescents are nearly identical to those in adults. In addition to the nine clinical symptoms seen in BPD in adults, there are other signs to look for in teenagers. These include a tendency to see people or situations in black and white, dangerous impulsivity, especially during stressful situations, an inability to read other people’s emotions, angry outbursts disproportionate to situations, and a history of conflict with family and friends.

Teenagers with BPD may struggle with forming and maintaining healthy relationships, as they often exhibit intense and unpredictable reactions to others. They may also have a distorted self-image and struggle with self-esteem issues, leading to behaviors like self-harm or suicidal thoughts.

The prevalence of BPD among adolescents varies greatly across studies. However, a 2022 Canadian study using a sample of 799 adolescents ages 12 to 14 found a prevalence rate of 2.6% for males and 3.9% for females. Teenagers with the highest prevalence rates were those who were severely impaired or suicidal. For these teens, the prevalence of BPD ranged from 11% in adolescents consulting at outpatient clinics to as high as 78% in suicidal adolescents.

The risk factors for developing BPD in teenagers include a combination of childhood adversity, personality traits, and environmental factors:

  • Childhood Adversity: A history of childhood abuse, neglect, or trauma is a significant risk factor for adolescent BPD. The severity of neglect and abuse can increase the likelihood of developing BPD.

  • Personality Traits: High levels of neuroticism, which is a personality trait characterized by emotional instability, anxiety, and moodiness, have been linked to a greater risk of BPD in adolescents.

  • Family and Social Environment: Low socioeconomic status, family psychopathology, poor parent-child relationships, and traumatic events such as extended maternal separations before age 5 are environmental factors that contribute to the risk of BPD.

  • Social Influences: Experiences like bullying and peer rejection can also be risk factors for BPD.

  • Genetic Predisposition: There may be a genetic component to BPD, although findings on this aspect are not entirely consistent.

  • Early Psychopathological Features: Early signs of psychopathology in children, along with associated neurobiological alterations, can progress to BPD.

Of course, the presence of these risk factors does not guarantee that a teenager will develop BPD, but they do increase the likelihood. Early detection and intervention can help mitigate these risks and improve outcomes for those with BPD.

Despite the abundance of evidence for the effectiveness of psychotherapy in adults with BPD, evidence is scarce on the effectiveness of treatment for BPD in adolescents. Psychotherapy has been shown to significantly reduce BPD pathology and self-harm in adolescents, but these effects were somewhat fleeting and disappeared at follow-up when compared to control treatments. The effects of BPD interventions in adolescence appear to be modest and particularly unstable at follow-up.

While there are promising signs that treatment can be effective for teens with BPD, the research is still developing, and the long-term stability of treatment outcomes requires further study. The current evidence suggests that early intervention and a structured therapeutic approach are key to improving outcomes for adolescents with BPD.

Source Material: Psychiatric Times, ncbi.nlm.nih.gov, Mcleanhospital.org, Choosingtherapy.com